Monday, May 30, 2011

Rethinking Choice: Human Personhood and the Abortion Debate

Fetal Development
Update: It has come to my attention that the timeline I'm describing has an error by a week or two. I don't have time to fix it, but the underlying idea is sound.

One of the most politically important questions of our day is defining the bounds of a human life, and who has control over it. This is in large part because it is so divisive, a treacherous landscape governed mainly by religious and political motivations, rather than by empirical truths, and serves as a distraction from the truly critical issues facing our country. It is therefore imperative that we formulate and proactively support a definition of human life that accounts for both fetal development and the fact that the mother and fetus are a single, integrated system.

The political landscape

The current status quo, established by Roe v. Wade is that human life can be legally defined to begin anytime between 50% viability (~22 weeks) and birth on a state-by-state basis, as long as those states provide an exception for the health of the mother. Pro-life groups are working to assault this beachhead on all fronts, from legislation that protects fetuses as full individuals in homicides, to restricting the times and places when abortion is allowed, to threatening doctors providing abortions.

Women’s rights groups have understandably entrenched themselves on this beachhead and react forcefully to any perceived movement away from this front. Officially, some pro-choice groups like NARAL Pro-Choice America acquiesce to restrictions conforming with Roe v. Wade, but many people who consider themselves pro-choice personally think that life begins begins at birth and that there should be absolutely no restrictions on abortion. However, defining life to begin at birth makes even less sense than conception.

Why not birth?

Historically, birth has been considered the event that marks the beginning of a human life. We celebrate the anniversary of our birth, and all measures of significance have been based on the time passed since this event. Birth is the moment when a fetus becomes independent of its mother, and generally occurs when the baby can survive outside the womb.

But take the example of identical twins in the moment after one has been born and while the other is still in the womb. Does it make sense to hold that the twin outside the womb is a person and the twin inside is no more than an extension of the mother? It should be clear, therefore, that birth is a poor marker for the beginning of human life.

Why not conception?

Life technically doesn’t have a beginning. The sperm and egg that came together to form you were both individually alive, and those gametes ultimately originated from the sperm and eggs that formed the organism’s parents, and so on in an unbroken chain back to the origin of life over 3 billion years ago.

So we can’t really say that life begins in any absolute sense. But what makes one individual distinct from another? To a large extent, this would be the individual’s base genome*. Conception is the first time that this unique genome comes together from the half-genomes of the sperm and egg, so on some level it might seem like this is a good place to define the start of human life.

This isn’t sufficient either. A zygote may be a cell undergoing a program that will lead, eventually, to a human being, but it is a single cell nonetheless. Consider that living cells taken from a person, even whole tissues or organs, would not themselves be considered protected human life, even when one of them has been reprogrammed into an embryonic state (though no human clone has progressed very far, that we know of). Also consider that identical twins—two distinct individuals—result from a single embryo that at some point split into two separate groups of cells. The zygote certainly wouldn’t have counted as two people prior to the splitting event.

If it is later than conception, but earlier than birth, when can we consider human life to begin? Often when scientists are asked about this issue, they will say that science can’t answer the question as it is one of values rather than of mechanisms. In my view, this is a cop-out intended to deflect any criticism that could threaten their funding. While it is true that the scientific method is unable to answer such questions, we can—and should—use empirical evidence to inform our values.

What exactly is a “human life”?

Before we go any further, it is worthwhile to figure out exactly what we really mean when we talk about the beginning of a “human life.” It is perfectly clear that a newborn baby is a human life, as is a healthy teenager, adult, or elderly person. Perhaps we can take a lesson here from how we define death. If a human’s brain has been destroyed or has ceased functioning, we declare the person dead (hence, “brain dead”), even though many of their individual cells are still alive and organs still functional. When we talk about a human life, we are talking about an entity that can think and experience, not an entity that only breathes and pumps blood—a person.

Cerebral development

From the above definition, we can naturally tie the concept of human life to a functional cerebrum (the outer, wrinkled bulk of the human brain involved in all the higher functions). So when does this occur? At ~24 weeks, the brain begins to be able to control some bodily functions, and by ~28 weeks, the thalamus connects the sensory organs to the rest of the brain. So if we are to define human life as parallel to the human brain, it would be quite logical to place the beginning of human life at the time when the brain has reached a critical stage of development, which would be around 24-28 weeks of pregnancy.

“Human life” typically begins between 24 and 28 weeks of development

So what does this all mean, legally and morally? It means that between 24-28 weeks and birth, a fetus should gain some of the same protections that a baby would. However, any laws developed still need to recognize the tightly interlinked relationship between the mother and the fetus during this time, and continue to give precedence to the life of the mother if there is ever a conflict between the two.

I’m not the only person to come up with this, however. Dr. Richard Hull and Dr. Paul Penner of the University of Buffalo published a full ethical analysis in Journal of Medicine and Philosophy in 2008 and came to essentially the same conclusion.

Implications for research

One immediate question is whether this definition allows unlimited research on human fetuses up to the 24-28 weeks period. I don’t believe that would be the case. The furthest I would be comfortable seeing in the laboratory—though with appropriate oversight—is maybe before the fetal period begins. Of course, it would not be technically possible to go much further anyway due to placental implantation necessity. Though I recognize that this might be an emotional position rather than a logical one.

Implications for crimes resulting in death/injury to a fetus

There is a push to include fetuses as full persons for the purpose of criminal law. I can recognize the need for such a thing in general. A pregnant woman who is the subject of an assault resulting in a miscarriage would suffer a greater loss than an assaulted pregnant woman who doesn’t suffer a miscarriage, and the law should reflect that. However, prior to CNS maturation, it must do so by folding it in as part of the injury to the woman. Only after 24-28 weeks could the law treat the fetus as a baby for the purposes of such crimes, and of course must still be carefully crafted to allow for the medical necessity of abortion, as discussed below.

Implications for abortion

Although decisions about what constitutes a human life impact a number of issues, the most visible flashpoint is abortion.

Up to 24-28 weeks, abortion should be at the option of the mother carrying the fetus. After this period, however, abortion should be limited to cases where the mother’s health is at risk, if there is an extreme neurological birth defect (e.g. an-/microencephaly, misplaced organs), or the mother seems likely to take matters into her own hands (though this could be a tricky exception). But when indicated, preterm birth and adoption would be preferable to abortion during this period. Additionally, enforcement of such laws must necessarily be limited to cases where the violation of any of these considerations is unambiguous.

No abortion is a good abortion

Since I’m on the topic, I thought I’d say just a bit more on the topic of abortion. One thing everyone on both sides can agree on—though I don’t think many pro-life people realize it—is that no abortion is a good abortion. We must do what we can, as a society, to reduce the necessity for abortions. This includes:
  • Comprehensive sex education
  • Readily available contraceptives
  • Accessible, affordable healthcare for all women
These measures will help reduce the number of unwanted pregnancies, undetected pregnancies, and pregnancies that have complications due to lack of care. Anyone who considers themselves “pro-life” should be on board with this at a minimum, but sadly most of them seem to care more about punishing people for having sex than about reducing abortions.

Moving forward: a time for action

In order for this definition to work, pro-choice groups and individuals need to get behind it. This might be easier said than done for the reasons mentioned at the beginning of this post. However, one thing is clear: using birth as the initial demarcation for human life is philosophically weak and scientifically unsound. Pro-choice groups must become proactive in crafting the legislation that will circumscribe this definition so that we can be sure that it appropriately takes into account the full relationship between a developing fetus and its mother. If this does not happen and groups like NARAL continue to only react, we cede this solid ground to the pro-life groups, who are at this moment making a major and disturbingly successful push for anti-abortion legislation across the country.

*Although we often think of every cell in our body as having the same genome, this isn’t strictly true. Some cells undergo purposeful genomic reagents (immune cells), and virtually every cell in our body has accumulated some mutations compared to the original zygote.

Fetal development information was obtained from the MedlinePlus Encyclopedia's “Fetal development” and my own knowledge of embryonic development.

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